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General NPI Number Information
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NPI Number | 1811181464
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Entity Type | Individual
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Provider Name | THOMAS S DONOVAN L.C.P.C., L.P.H.A
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 428 N 6TH ST SUITE 202
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City | QUINCY
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State | IL
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Zip | 62301-2502
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Country | US
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Telephone | 217-228-0543
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Fax | 217-228-0543
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Provider Business Mailing Address
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Address Line | 428 N 6TH ST SUITE 202
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City | QUINCY
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State | IL
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Zip | 62301-2502
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Country | US
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Telephone | 217-228-0543
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Fax | 217-228-0543
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180004945
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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